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What is Transrectal Ultrasonography (TRUS)?

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Transrectal ultrasonography (TRUS) is a non-invasive diagnostic imaging tool used to create an image of the prostate gland using sound waves. The procedure involves placing a small probe, called the ultrasound transducer, into the rectum. Painless sound waves are beamed at the prostate, and the waves that are reflected back are transformed by a computer into images on a video screen.

How Does TRUS Work?

TRUS is different from conventional ultrasound procedures. In conventional ultrasound procedures, a probe placed against the skin sends painless, ultra-high-frequency sound waves into the body. As the waves strike internal organs, they produce echo patterns that a computer converts into images (sonograms) on a video screen.

In TRUS, the ultrasound transducer is inserted into the rectum. Painless sound waves scan the prostate gland in two planes, creating a detailed image of the gland. The resulting pictures can help guide a biopsy of the prostate, helping to pinpoint suspicious areas.

When is TRUS Recommended?

Doctors may recommend TRUS when they suspect prostate cancer based on an abnormal digital rectal exam (DRE) or an elevated prostate-specific antigen (PSA) level. However, TRUS is costly, and it rarely detects prostate cancers that a DRE or PSA cannot find. As a result, although TRUS is commonly used to guide a biopsy, it’s not recommended for routine screening.

Benefits of TRUS

TRUS is a non-invasive procedure that doesn’t require anesthesia or sedation. It’s also quick, usually taking only 10-15 minutes to complete. TRUS is a valuable tool in guiding prostate biopsies, allowing for more accurate targeting of suspicious areas of the prostate gland.

  1. Non-invasive: TRUS is a non-invasive diagnostic tool that does not require anesthesia or sedation. This means that it can be performed quickly and easily in an outpatient setting without the need for hospitalization.
  2. Accurate: TRUS is a highly accurate tool for detecting abnormalities in the prostate gland, such as tumors or cysts. It can also help guide the placement of biopsy needles, increasing the accuracy of biopsy results.
  3. Quick: TRUS is a relatively quick procedure, usually taking only 10-15 minutes to complete. This means that patients can often schedule the procedure during a routine office visit.
  4. Safe: TRUS is a safe procedure with very few risks or complications. Some patients may experience minor discomfort or bleeding after the procedure, but these symptoms usually resolve quickly.
  5. Guided biopsies: TRUS is commonly used to guide prostate biopsies, allowing for more accurate targeting of suspicious areas of the prostate gland. This can help improve the accuracy of biopsy results and reduce the need for repeat biopsies.
  6. Customizable: TRUS can be tailored to individual patients, depending on their specific medical needs and concerns. The procedure can be performed at different angles and depths, allowing for a customized approach that maximizes diagnostic accuracy.
  7. Cost-effective: While TRUS is not recommended for routine screening due to its cost, it is often more cost-effective than other diagnostic tools, such as MRI or CT scans.

It is important to note that while TRUS has many benefits, it is not always the best diagnostic tool for every patient.

Limitations of TRUS

  1. Can miss small cancers: TRUS is not always able to detect small cancers in the prostate gland. This is because some cancers may not be visible on the ultrasound image or may be obscured by other structures in the body.
  2. False positives: TRUS can sometimes produce false positive results, meaning that it can indicate the presence of cancer when there is none. This can lead to unnecessary biopsies and anxiety for patients.
  3. Not recommended for routine screening: While TRUS is a useful tool for guiding prostate biopsies, it is not recommended for routine screening. This is because it is expensive and rarely detects prostate cancers that a DRE or PSA cannot find.
  4. Invasive: TRUS is an invasive procedure that involves inserting an ultrasound probe into the rectum. This can be uncomfortable or even painful for some patients.
  5. Operator-dependent: The accuracy of TRUS depends on the skill and experience of the operator performing the procedure. This means that there can be variation in the quality of TRUS images and results from one operator to another.

It is important to note that while TRUS has limitations, it is still a valuable tool in the diagnosis and treatment of prostate cancer. Your doctor can help determine if TRUS is the right choice for you based on your individual medical history and symptoms.

Conclusion

In conclusion, TRUS is a non-invasive diagnostic tool that can help detect prostate cancer. The procedure involves placing an ultrasound transducer into the rectum and using sound waves to create an image of the prostate gland. TRUS is commonly used to guide a biopsy, allowing for more accurate targeting of suspicious areas. However, it’s not recommended for routine screening due to its limitations and cost. If you have any concerns about prostate cancer, speak to your doctor about whether TRUS may be right for you.

Wynne Lee, MD

Dr. Wynne Lee is a physician at Massachusetts General Hospital (MGH), where she provides primary care.

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